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Navy S Marine Corps Medical News 


Jan 21, 2000 

The Navy Bureau of medicine and Surgery distributes Navy 
and Marine Corps Medical News (MEDNEWS) to Sailors and 
Marines, their families, civilian employees and retired Navy 
and Marine Corps families . To achieve maximum medical 
information distribution, your command is highly encouraged 
to distribute MEDNEWS to ALL HANDS electronically and 
include MEDNEWS in command newspapers, newsletters and radio 
and TV news programs. Visit the Navy Medicine web sites at or 
http : //navymedicine . med. navy . mil . 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional' s name to show affiliation: MC - 
Medical Corps (physician) ; DC - Dental Corps; NC - Nurse 
Corps; MSC - Medical Service Corps (clinicians, researchers 
and administrative managers) . Hospital Corpsmen (HM) and 
Dental Technician (DT) designators are placed in front of 
their names. 


Contents for this week's MEDNEWS: 

Headline: DoD leaders address TRICARE issues 

Headline: Flu victims breathing easier with San Diego ventilators 
Headline: Improved TRICARE dental program is on the way 
Headline: Millennium Veterans Act beefs up long-term care 
Headline : Proper shoes help athletes avoid pain of defeat 
Headline: Anthrax question and answer 

Headline: Great Lakes TRICARE forum addresses beneficiary concerns 
Headline: TRICARE question and answer 

Headline: Healthwatch: Detectors catch a deadly house guest 


Headline: DoD leaders address TRICARE issues 

By Linda D. Kozaryn, American Forces Press Service 

WASHINGTON — Complaints about TRICARE have not fallen on 
deaf ears. Defense leaders say they have heard about 
service members ' frustrations , and plans are under way to 
fix the system. 

Defense Secretary William S. Cohen told reporters in 
early January he would soon make a major announcement on how 
DoD plans to improve military health care. He and Army Gen. 
Henry Shelton, chairman of the Joint Chiefs of Staff, have 
both pledged that the improvement of health care is one of 
their top priorities in the year ahead. 

Service members receive quality health care, but related 

business practices are causing headaches , Mary Gerwin 
recently told the American Forces Press Service. After she 
visited troop bases in Italy and the Balkans, the deputy 
assistant defense secretary for health affairs said access 
to health care is a major concern to service members. 

"Even though our surveys find that people are very happy 
and satisfied when they see the doctor and get the care they 
need, there is a problem getting appointments, " Gerwin said. 
People complain about having to hold for long periods when 
they call to make an appointment and that it takes too long 
to get to see a doctor, she said. People feel that "access 
standards" allowing patients to be seen within a few days or 
a few weeks are not being met, she said. 

DoD officials are determined to fix these types of 
problems. Dr. Sue Bailey, assistant defense secretary for 
health affairs, has directed that military treatment 
facilities adhere to established access standards and to 
have more of a standardized appointment system. Officials 
want to make it easier to get appointments and to ensure 
patients are directed to the right caregiver, Gerwin said. 

"What we find sometimes is that patients will have a lot 
of their time wasted because they're sent to the wrong 
clinic, " she said. A patient with a shoulder injury, for 
example, may be sent to a knee specialist. "They ' re sent to 
the wrong clinic because the person making the appointments 
from a centralized appointment system is not familiar with 
the actual clinic and what it does. So that ' s very 
frustrating from the patient's standpoint." 

Service members also say they're having a difficult time 
getting claims paid, Gerwin said. Families are getting 
notices that the doctor bills have not been paid or, in 
cases where they paid the bill up front, service members are 
not getting reimbursed. Incorrectly completed claim forms 
are being returned to the provider, she noted, thereby 
delaying payment . 

"We 're working hard to fix the claims processing system 
so that a service member and his or her family will never 
get a notice that says the bill was not paid, " Gerwin said. 
"That is our goal so that service members don't have the 
feeling that they're going to get bad credit because they 
had an unpaid bill . " 

DoD health affairs officials are addressing these 
problems in several ways. "We're reforming the claims 
process so that we 're paying our claims in a shorter period 
of time, " Gerwin said. "We 're also trying to simplify the 
process so that it ' s easier for providers to submit claims. " 

Service members ' concerns about care after retirement 
affect recruitment and retention. When they hear claims 
about broken promises from retirees in their communities , 
service members naturally question whether health care will 
be there for them when they retire, " Gerwin explained. DoD 
is now exploring ways to best extend coverage to people over 
age 65. "At age 65, you're no longer eligible for CHAMPUS, " 
she said. "That ' s why we have to find other ways of doing 

it. " 

DoD officials are particularly concerned about caring for 
service members ' families when units deploy. Service 
members should not have lingering concerns about their 
families ' care, Gerwin said. "We have to try harder to get 
those bills paid on time, because health care is a high 
quality of life issue for our troops. " 

Many service members acknowledge that TRICARE is still 
fairly new and getting used to it is taking some time, 
Gerwin said. Commanders, in particular, say they need more 
education — more help in being able to explain the program. 

"We've got a big education effort under way, " she said. 
"Our job is to simplify the system as much as possible and 
then educate commanders and people within the community so 
they're able to answer service members' and their families' 
questions . " 

Health care is complicated, Gerwin said. "We 're trying 
to simplify the message as much as possible . We really 
encourage people to get good briefings when they sign so 
they know who to call for care and how that care is going to 
be delivered, " she said. 

Military and civilian consumers are dealing with many of 
the same health care issues, Gerwin noted. These include 
high prescription drug costs, claims processing snafus, a 
more complicated health care system, and patients having to 
do more to manage their own care. 

"We can only go as fast as the overall health care 
industry does, " she remarked. "What we can do is make sure 
we've adequately budgeted for our program, so we have enough 
to give that very good level care. 

"A good example of that is our prescription drug costs. 
Much like the rest of the overall health care system, we 
have prescription drug costs that are skyrocketing . We have 
to make sure we put enough dollars in the system so the 
drugs are available for individuals . " 

DoD's goals, she said, are to "get the onus off the 
beneficiary" and make the system as easy to use as possible . 
"The major initiatives are to make sure those 
phones are answered, that people are able to get their 
appointments on time, that they get their claims paid, and 
that they feel they have the access to the care they 
deserve. " 


Headline: Flu victims breathing easier with San Diego 

By Doug Sayers, Naval Medical Center San Diego 

SAN DIEGO, Calif. - Christmas was misery for many San 
Diego County residents this year. It seemed Santa brought 
the flu, the gift that just keeps giving. Into the new 
year, area hospital emergency rooms were packed, and 
hospitals filled quickly with flu sufferers. 

With influenza comes respiratory problems, and getting 
oxygen to the lungs might require mechanical assistance in 

the form of ventilators. For many area hospitals, Naval 
Medical Center San Diego is supplying those ventilators . 

Ron Miller, head respiratory therapist at Balboa said 
requests to borrow ventilators have been coming in since 
before Christmas. 

"Balboa has 20 ventilators loaned out to area hospitals 
all over the county, " he said. "With ventilators from the 
USNS Mercy (T-AH 19) and from the Medical Center, we can 
just about meet their requests." 

Before any of the ventilators get sent out, each one is 
inspected and certified to ensure they function properly. 
Cmdr. Tom Chohany, MSC, assistant director for 
administration said, "Our respiratory therapists and 
biomedical repair personnel have done an outstanding job 
getting the ventilators ready and out to the other 
hospitals . Not only have they made sure our patients have 
plenty of working ventilators, they've taken on the extra 
task of helping our neighbors who are relying on us. " 

This isn't the first time Balboa has been able to provide 
extra ventilators to the community. According to Miller, 
Balboa and Mercy were asked to send two dozen ventilators 
out during the flu epidemic of 1998. Miller said, "We were 
able to help out then, and I'm glad we were able to come 
through again. I'm proud of my therapists and the role we 
play in patient care — whether at Balboa or helping area 
hospitals with ventilators . " 


Headline: Improved TRICARE dental program is on the way 
From TRICARE Management Activity 

FALLS CHURCH, Va. — The TRICARE Management Activity (TMA) 
recently announced the release of the Request for Proposal 
(RFP) for offers on the world's largest dental insurance 
program - the TRICARE Dental Program (TDP) . 

This new "third generation" dental contract will be 
implemented February 1, 2001, and it will combine the 
TRICARE Selected Reserve Dental Program (TSRDP) and the 
TRICARE Family Member Dental Plan (TFMDP) . 

The TDP will provide improved dental coverage for active 
duty family members, and eligible reserve component 
personnel (Active Reserve and National Guard, Selected 
Reserve, Individual Ready Reserve) and their family members 
worldwide . 

Since implementation of the TFMDP in 1987, just two 
dental insurance companies have administered it - originally 
Delta Dental of California, and currently United Concordia 
Companies, Inc. 

This new third generation TDP has evolved into an 
enhanced program that will employ efficient commercial 
practices to administer this vital quality of life benefit, 
aimed at improving overall dental health for members by 
encouraging enrollment and use of the program. 

A major improvement reduces the 24-month mandatory 
enrollment period, which previously barred some active duty 

family members , and reserve component personnel and their 
family members from enrolling in the current TFMDP. The TDP 
requires the sponsor to have 12-months of service remaining 
at the time of enrollment . 

"The TDP is a great dental program and we wanted to open 
the doors to allow more military members and their families 
to enroll in and use the program" said Capt. Lawrence 
McKinley, DC, TMA's senior consultant for dentistry. 

The new plan also permits reservists and their family 
members to enroll in the TDP if the reservist is called to 
active duty in support of a contingency operation for more 
than 30 days but less than 12 months. Since most employer 
based dental policies require the employee to pay full 
premium costs while on active duty, the TDP provides the 
activated reservist and family members with a low cost, 
comprehensive dental program while on active duty. The 
reservist also has the option of enrolling his/her family 
members in the TDP and not themselves. 

Enrollment in the TDP will also be more user friendly and 
efficient because the new contractor will administer the 
enrollment function instead of the personnel departments of 
the uniformed services . The contractor will have "real 
time" online access to DEERS to validate eligibility . 

McKinley said, "We felt enrollment was best achieved 
through an experienced dental insurance company that 
performs this function as part of its commercial business 
practice . " 

Certain reservists and family members of incarcerated 
sponsors who were previously excluded from enrollment 
because they did not have an active payroll account will now 
be able to enroll because the contractor will directly bill 
them for their monthly premium. 

Yet another improvement in the is an increase in the 
maximum benefit coverage: $1,200 annual maximum for routine 
care and $1,500 orthodontic lifetime maximum. 

There is also a staged cost share structure that reduces 
cost shares for enlisted personnel (Els to E4s) . Because 
costs cause some lower ranking enlisted families to not seek 
dental care, the reduction in cost shares for some dental 
procedures will ease costs and encourage dental health. 

Although the mandatory enrollment age for children is 
four years old, sponsors may enroll children at age one. 
The new TDP strongly encourages diagnostic and preventive 
dental care for children prior to the mandatory enrollment 

Contractors must develop dental programs that encourage 
network providers to use recognized diagnostic and 
preventive guidelines for pediatric and adolescent dental 

"Good dental health is an important facet of overall good 
health. As with medical preventive care, dental preventive 
care should start at a very early age, " said McKinley . "One 
of TMA's primary goals for the TDP is to urge beneficiaries 
to seek early preventive dental care to avoid more serious 

and more costly dental diseases . " 

Although the TDP contains many of the aspects of the 
current TFMDP, its approach is innovative. It incorporates 
the principal themes of increasing enrollment and 
encouraging early preventive dental care for the good of the 
beneficiaries' overall health. 

"The TMA has worked very hard to design a dental program 
that promotes enrollment and use of this important dental 
benefit. All the improvements and enhancements in the 
program were developed with improving the dental health of 
the beneficiary in mind - the desired outcome being that 
people will take their dental health more seriously and 
enroll in and use the TDP, " McKinley said. 

The winning contractor will be announced in late spring 
2000 and will begin the transition phase for implementing 
the new TDP program for a February 1, 2001, start-up . 


Headline: Millennium Veterans Act beefs up long-term care 
By Jim Garamone American Forces Press Service 

WASHINGTON — Veterans will be entitled to improved, 
long-term care and other benefits thanks to a new law signed 
by President Clinton in November. 

The comprehensive Veterans Millennium Health Care and 
Benefit Act directs the Department of Veterans Affairs to 
improve access to long-term care for disabled veterans. It 
also provides veterans with other health care benefits, new 
veterans' cemeteries and educational benefits. 

The VA will also examine innovative ways to provide 
nursing home care and ways to help families . Specifically, 
the VA will provide geriatric evaluation, nursing home care 

- either in VA facilities or in community-based facilities, 
home care services, adult day health care, noninstitutional 
alternatives to nursing home care and respite care. 

The new law includes provisions that : 

- Extend the housing loan program for members of the reserve 
components who serve at least six years to 2007. The 
current program expires in 2003. 

- Permit veterans to use their Montgomery GI Bill money to 
pay for preparatory courses such as those readying students 
to take the Scholastic Aptitude Test or the Graduate Record 

- Authorize VA to pay reasonable emergency care costs for 
veterans who receive their medical care from VA. 

- Authorize VA to provide care to TRICARE-eligible military 
retirees and Purple Heart recipients . 

- Direct VA to examine the creation of six new national 
veterans' cemeteries. While not specifying where the new 
cemeteries should be, the law urges VA to closely examine 
such "underserved" areas as Detroit, Atlanta, Miami, 
Pittsburgh, Oklahoma City, and Sacramento, Calif. 

- Add bronchiolo-alveolar carcinoma, a rare form of lung 
cancer not associated with tobacco use, to the list of 
service-connected diseases for Atomic Veterans. 

- Authorize the American Battle Monuments Commission to 
borrow $65 million from the U.S. Treasury to begin 
construction of the World War II Memorial in November 2000. 


Headline : Proper shoes help athletes avoid pain of defeat 
By JOl Duke Richardson, Naval Medical Center Portsmouth 

PORTSMOUTH, Va . — Feet bear much of the burden for most 
athletic activities . Selecting the right athletic shoe is 
as equally important as selecting the right golf club or 
tennis racket. A well- fitting, well-made and properly used 
athletic shoe can help reduce foot problems and increase 
performance . 

"Feet are made to bear tremendous pressure, " says It . 
Cmdr . Paul Spada, MC, a podiatric surgeon. "An average day 
of walking brings a force equal to several hundred tons to 
bear on the feet . Weight bearing sports like running and 
aerobics put even more pressure on the feet and ankles." 

Selecting the right athletic footgear for each sport is 
important for overall foot health. There are athletic shoes 
for just about every sport : 

- Cycling: The casual rider without foot problems can use 
cross-training shoes (i.e. combination cycling/hiking 

shoes) , which provide support across the arch and instep in 
a shoe as well as the heel lift that cycling shoes give. 

- Golf: Today' s golf shoes are constructed using basic 
principles of athletic footwear. Advanced technological 
innovations keep golf shoes light and add strength. 

- Running: Weight, foot structure, and running regimen 
should determine shoe choice. Shoes differ in size and 
shape among different brands and within the same brand. 
Proper fit is the key. 

Tennis: Proper tennis shoes "give" enough to allow for 
side-to-side sliding. In addition, tennis shoes need to 
have padded toe boxes to prevent injuries . 

Walking: The ideal walking shoe should be stable from 
side to side, well cushioned and it should enable you to 
walk smoothly. Running shoes are acceptable for walking, 
but specialty walking shoes tend to be slightly less 
cushioned, not as bulky and lighter than running shoes. 

- Children' s athletic shoes: It's not the brand name or 
price tag of an athletic shoe that makes the difference in a 
child's foot health. Foot care specialists agree it's often 
better to buy two pairs of less expensive shoes than a 
single expensive pair. This allows rotation in wearing to 
avoid rapid wear deterioration. Excessive wearing of the 
out-sole, loss of shoe counter support or wearing out in the 
mid-sole indicate it's time to replace the shoes. 

General shoe buying tips: 

- Shop for shoes later in the day; feet swell during the 


- Have your feet measured while you're standing. 

- Try on shoes while you're wearing the same type of sock 
you'll be wearing with the shoe. 

- Buy for the larger foot, both feet are rarely the same 


- Always try on both shoes and walk in the shoes before 
buying them. 

- Shoes should feel comfortable immediately, not needing 
a break-in period. 

- Be sure that the widest part of your foot fits the 
widest part of the shoe. 

- Because children' s feet are constantly growing, allow 
at least one finger's width from the end of the longest toe to 
the tip of the shoe. 


Headline: Anthrax question and answer 
From Bureau of Medicine and Surgery 

Question: Has the threat of biological warfare changed? 

Answer: The threat of biological warfare has been a risk 
to U.S. forces for many years. DoD analysts maintain an 
updated evaluation of the level of threat, adjusting the 
information as necessary to reflect the risk to U.S. 
operations . 

Assessment of the potential offensive biological threat 
facing American service men and women indicate it is 
necessary to have a robust biological defense program today. 
The threat is real and consequences are grave — former 
Director of the CIA James Woolsey referred to it as the 
single most dangerous threat to our national security in the 
foreseeable future. 

For more information visit the anthrax web site at 
http: //www . anthrax 


Headline: Great Lakes TRICARE forum addresses beneficiary 

BY LT Youssef H. Aboul-Enein, MSC, Naval Hospital Great 
Lakes PAO 

GREAT LAKES, 111 . — TRICARE beneficiaries from three 
Mid-America states recently learned about health, wellness 
and health coverage issues for 2000 during National Health 
Observance Days seminars at Great Lakes Naval Hospital . 

Health benefits advisors, pharmacists, dieticians and 
TRICARE specialists provided information about pre-natal 
care for pregnant women, prescription services, and 
cholesterol advice, among other topics. 

Beneficiaries also learned that pre-natal care for women 
will still occur at Naval Hospital Great Lakes, but 
deliveries will occur at Condell Medical Center in 
Libertyville, Illinois . 

Even customers who had been affiliated with Navy Medicine 
wanted undated information about today's medical service. 

"I am a retired Nurse Corps Officer with 27 years of 
service, and I wanted to learn more about the services the 
Great Lakes Naval Hospital can provide, " said Lt. Cmdr. Dan 

Frazee . 

Jennifer Tref finger, health promotion specialist , 
provided information about breast cancer and cholesterol 
issues at her information table. 

"We maximize National Health Observance Days in Great 
Lakes to keep our patient population not only aware of 
health issues but to seek appointments and be active in the 
prevention of disease, " she said. 

Tref finger said that September was Cholesterol Month and 
January 2000 is Cervical Health Month and in each of these 
months the Naval Hospital plans screenings, programs and 
general awareness of the diseases for TRICARE beneficiaries . 

"We are trying to improve the systems, but we rely on 
these forums for us to be effective advocates between you 
and the healthcare contractors , " Steve McGinnis , head of 
coordinated care told the audience. 

Lt . Cmdr. Maria Marioni, MSC, head of pharmacy discussed 
drugs in the latest formulary. She said that it takes into 
consideration the needs of retirees and is more aligned with 
the three services. 

To ease customer' s concerns about health care when away 
from their normal catchment area, Health Benefits Advisor 
Estelle McKenna urged enrollees to take a TRICARE card 
listing toll-free numbers that could be called 24-hours a 
day. Using the numbers would expedite for hospitalization 
or care and avoid unnecessary costs. 

The TRICARE Service Centers at Great Lakes and at other 
MTFs exist to help all beneficiaries make the most of their 
healthcare benefits, book appointments and help in the 
adjudication of claims. 

Among the attendees at the forum was an infantry veteran 
of the Korean War who wanted help understanding his 
entitlements . He met service center representatives who are 
assisting him and his wife by explaining services offered at 
Great Lakes Naval Hospital . 

Capt. Elaine Holmes, MC, commanding officer of Naval 
Hospital Great Lakes, urged retirees and those over 65 to 
get the most of their health benefits by seeking help from 
the TRICARE experts at the forum. 

She described the services of the new Family Practice 
Wing, which has Blue and Gold Teams for easier access for 
patients . She said these procedures represent the way 
medicine will be practiced in the 21st century. The new 
wing combines access with one-stop shopping for medical 
care, preventive medicine, wellness and pharmaceutical 
needs . 


Headline: TRICARE question and answer 
From Bureau of Medicine and Surgery 

Question: Does the enrollment fee for retired members in 
TRICARE Prime have to be paid all at once, or can it be paid 
in installments? 

Answer: It is permissible to pay the Prime enrollment fee 
in quarterly installments. There is no additional 
administrative fee for quarterly payments . 


Headline: Healthwatch: Detectors catch a deadly house guest 
By Kimberly A. Rawlings, Bureau of Medicine and Surgery 

WASHINGTON — There could be a silent killer in your 
house - roaming the halls, lurking in every room and looming 
over your bed. 

That silent killer is carbon monoxide, which is a 
colorless, odorless and tasteless gas that can kill you 
before you even realize it's inside your home. 

"It can go undetected with no warning signs, " said Lt . 
Cmdr. Michael Macinski, MSC, industrial hygiene officer. 

Carbon monoxide is one of the most common indoor poisons, 
according to Macinski. Ten to 15 thousand people are 
diagnosed with carbon monoxide poison and 300 to 400 
fatalities are reported each year. 

When carbon monoxide is inhaled, it is immediately 
attracted to the hemoglobin in red blood cells. While in 
the bloodstream it displaces the oxygen that the cells need 
to function. If enough carbon monoxide is inhaled, you can 
essentially suffocate from the inside out, as the blood 
carries less and less oxygen throughout the body. 

Carbon monoxide is a by-product from the incomplete 
combustion of gas, oil, kerosene or wood. Gas appliances 
(heaters, dryers, stoves, etc.) will normally produce very 
little, but kerosene and oil heaters produce higher 
concentrations . 

Determining if you are being poisoned may be difficult . 
Known as the "The Great Imitator, " carbon monoxide often 
gives symptoms that resemble other common diseases, such as 
the flu. Low level poisoning can give the symptoms of 
headaches, fatigue, nausea, dizzy spells and confusion. 
Exposure to a high concentration of carbon monoxide can be 
fatal in a matter of minutes. 

If you suspect that you are suffering with carbon 
monoxide poisoning, have your doctor give you a 
carboxyhemoglobin test . This test can determine the amount 
of carbon monoxide currently in your body. The poisoning 
can be reversed if caught in time. Acute poisoning may 
result in permanent damage to parts of the body that require 
a lot of oxygen, such as the heart and brain. 

But these medical extremes can be avoided if preventive 
measures are taken. 

"Carbon monoxide detectors are an inexpensive way to save 
your life, " said Macinski . "They are especially useful to 
people that use fossil fuel to heat their house, for 
example, natural gas, oil, kerosene or wood. " 

The Consumer Product Safety Commission recommends that 
consumers install at least one carbon monoxide detector in 
their home. Detectors should be installed near sleeping 
areas and at least ten feet from appliances . They should be 

kept away from high air turnover - near ceiling fans and 
vents - that will mask carbon monoxide concentrations. 

The standard detector requires the alarm to sound before 
an average, healthy adult begins to experience any symptoms . 
If the detector goes off, leave the house immediately and 
call the fire department from a neighbor' s phone. Re-enter 
the home only after directed by the fire department . 

Using the carbon monoxide detector will help you keep the 
unwanted guest, carbon monoxide, from your home. 


Comments about and ideas for MEDNEWS are welcome . Story 
submissions are encouraged. Contact MEDNEWS editor, Earl W. 
Hicks, at email:; Telephone 202/762— 
3223, (DSN) 762-3223, or fax 202/762-3224.